Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Dec 6;9(12):23259671211050899.
doi: 10.1177/23259671211050899. eCollection 2021 Dec.

The Evolution of Arthroscopic Rotator Cuff Repair

Rony-Orijit Dey Hazra  1   2 , Justin J Ernat  1   3 , Dylan R Rakowski  1 , Robert E Boykin  1   4 , Peter J Millett  1   2
Affiliations
Review

The Evolution of Arthroscopic Rotator Cuff Repair

Rony-Orijit Dey Hazra et al. Orthop J Sports Med. .

Erratum in

Abstract

Over the past 30 years, arthroscopic rotator cuff repair (ARCR) has evolved to become the gold standard in treating rotator cuff pathology. As procedural concepts of ARCR continue to improve, it is also continually compared with the open rotator cuff repair as the historical standard of care. This review highlights the evolution of ARCR, including a historical perspective; the anatomic, clinical, and surgical implications of the development of an arthroscopic approach; how arthroscopy improved some of the problems of the open approach; adaptations in techniques and technologies associated with ARCR; future perspectives in orthobiologics as they pertain to ARCR; and lastly, the clinical improvements, or lack of improvements, with all of these adaptations.

Keywords: arthroscopic rotator cuff repair; orthobiologics; shoulder arthroscopy.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This research was supported by the Steadman Philippon Research Institute (SPRI), which is a 501(c)(3) nonprofit institution supported financially by private donations and corporate support. SPRI exercises special care to identify any financial interests or relationships related to research conducted here. During the past calendar year, SPRI has received grant funding or in-kind donations from Arthrex, Ossur, Siemens, Smith & Nephew, DoD, DJO, MLB, and XTRE. R.O.D.H.’s position at SPRI was supported by AGA via Arthrex for 1 calendar year. J.J.E. has received consulting fees from Medical Device Business Services. R.E.B. has received consulting fees from Smith & Nephew, nonconsulting fees from Arthrex and Smith & Nephew, and hospitality payments from Exactech. P.J.M. has received consulting fees from Arthrex and royalties from MedBridge and Springer and has stock/stock options in VuMedi. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Examples of suture-passing devices created to facilitate ease of suture passage during arthroscopic rotator cuff repair. (A) Smith & Nephew FIRSTPASS ST. (B) Arthrex Scorpion. (C) Various SutureLasso devices (Arthrex).
Figure 2.
Figure 2.
Examples of metal suture anchors in various sizes from Smith & Nephew, the TWINFIX Ti.
Figure 3.
Figure 3.
Examples of biocomposite suture anchors used for arthroscopic rotator cuff repair. From left to right: Arthrex BioComposite Corkscrew FT, Smith & Nephew Helicoil Regenasorb, and Arthrex BioComposite SwiveLock.
Figure 4.
Figure 4.
Examples of polyether ether ketone (PEEK) anchors used in arthroscopic rotator cuff repair. From left to right: Smith & Nephew Helicoil PK, Arthrex PEEK SwiveLock SP, and Smith & Nephew Footprint PK.
Figure 5.
Figure 5.
Example of an all-suture anchor used in arthroscopic rotator cuff repair, the Arthrex FiberTak.
Figure 6.
Figure 6.
Examples of high-strength sutures and tape used in arthroscopic rotator cuff repair that contain ultra–high-molecular-weight polyethylene. Top: Arthrex Fiber Tape. Bottom: Smith & Nephew Ultrabraid.
Figure 7.
Figure 7.
Arthroscopic rotator cuff repair constructs: (A) single row and (B) double row. Reprinted with permission from Roth KM, Warth RJ, Lee JT, Millett PJ, ElAttrache NS. Arthroscopic single-row versus double-row repair for full-thickness posterosuperior rotator cuff tears: a critical analysis review. JBJS Rev. 2014;2(7):e6. Wolters Kluwer Health.
Figure 8.
Figure 8.
(A) Early descriptions of the linking medial and lateral rows. (B) Displaying how the suture anchors are linked together. Image A reprinted with permission from Vaishnav S, Millett PJ. Arthroscopic rotator cuff repair: scientific rationale, surgical technique, and early clinical and functional results of a knotless self-reinforcing double-row rotator cuff repair system. J Shoulder Elbow Surg. 2010;19(2 suppl):83-90. ©2010, Elsevier Ltd. Image B reprinted with permission from Millett PJ, Mazzocca A, Guanche CA. Mattress double anchor footprint repair: a novel, arthroscopic rotator cuff repair technique. Arthroscopy. 2004;20(8):875-879. ©2004, Elsevier Ltd.
Figure 9.
Figure 9.
Evolution of the double-row arthroscopic rotator cuff repair. (A) Double-row repair. (B) Transosseous equivalent. (C) Knotless suture bridge construct with suture tapes. (D) Medial knotted suture bridge construct with sutures. Reprinted with permission from Roth KM, Warth RJ, Lee JT, Millett PJ, ElAttrache NS. Arthroscopic single-row versus double-row repair for full-thickness posterosuperior rotator cuff tears: a critical analysis review. JBJS Rev. 2014;2(7):e6. Wolters Kluwer Health.
Figure 10.
Figure 10.
The double-row, knotless, suture bridge arthroscopic rotator cuff repair using suture tapes and biocomposite suture anchors.
Figure 11.
Figure 11.
An example of a biologic scaffold used in the augmentation of arthroscopic rotator cuff repair wherein a biologic onlay is used to promote collagen formation and healing (REGENETEN; Smith & Nephew).
See this image and copyright information in PMC

References

    1. Apreleva M, Ozbaydar M, Fitzgibbons PG, Warner JJ. Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area. Arthroscopy. 2002;18(5):519–526. - PubMed
    1. Arnoczky SP, Bishai SK, Schofield B, et al. Histologic evaluation of biopsy specimens obtained after rotator cuff repair augmented with a highly porous collagen implant. Arthroscopy. 2017;33(2):278–283. - PubMed
    1. Bailey JR, Kim C, Alentorn-Geli E, et al. Rotator cuff matrix augmentation and interposition: a systematic review and meta-analysis. Am J Sports Med. 2019;47(6):1496–1506. - PubMed
    1. Barber FA, Dockery WD, Cowden CH III. The degradation outcome of biocomposite suture anchors made from poly L-lactide-co-glycolide and β-tricalcium phosphate. Arthroscopy. 2013;29(11):1834–1839. - PubMed
    1. Barber FA, Herbert MA. All-suture anchors: biomechanical analysis of pullout strength, displacement, and failure mode. Arthroscopy. 2017;33(6):1113–1121. - PubMed